The NEW ENGLA ND JOURNAL of MEDICINE

Perspective 

“When Will We Have a Vaccine?” — Understanding Questions

and Answers about Covid-19 Vaccination
Barry R. Bloom, Ph.D., Glen J. Nowak, Ph.D., and Walter Orenstein, M.D.​​

I
“When Will We Have a Vaccine?”

n recent months, epidemiologists in the United about the innovative and sophis-
States and throughout the world have been asked ticated technologies being used
needs to be replaced by consider-
the same question by clinicians, journalists, and ation of the actions and messages
members of the public, “When will we have a vaccine?” that will foster trust among clini-
cians and the public. Although
The obvious answer to this ques- pandemic conditions? Often, the vast investments have been made
tion would be, “When a candidate inquiry is also assessing whether in developing safe and effective
vaccine is demonstrated to be safe, the biotech and vaccine compa- vaccines, it is important to re-
effective, and available. That can nies, government agencies, and member that it is the act of vac-
be determined only by scientific medical experts involved in devel- cination itself that prevents harm
data, not by a target calendar oping, licensing, and recommend- and saves lives. Considered fully,
date.” But we realize that such a ing use of Covid-19 vaccines re- the question “When will we have
response, although accurate, over- alize that the responses they a Covid-19 vaccine?” makes clear
looks much of what people are provide now will influence what the many ways in which efforts
ultimately seeking to understand. happens later. There is often a related to both the “when” and the
The emphasis on “we” reveals sense that messages regarding “we” can affect vaccination uptake.
that most people want much more Covid-19 vaccines can have prob- Recognizing the significance of
than an estimated vaccine-delivery lematic framing (e.g., “warp both aspects of the question can
date. Their inquiry typically in- speed”) and make assertions that help public health officials and
volves three concerns. First, when involve key terms (e.g., “safe” and scientists both to hone current
will the public be able to have “effective”) for which experts’ messaging related to Covid-19
confidence that available vaccines definitions may vary and may vaccines and to build a better
are safe and effective? Second, differ considerably from those of foundation for clinicians who will
when will a vaccine be available the general public and key sub- be educating patients and par-
to people like them? And third, populations. ents about vaccination.
when will vaccine uptake be high As Covid-19 vaccines move into The recently released guide-
enough to enable a return to pre- phase 3 clinical trials, enthusiasm lines from the Food and Drug

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PERS PE C T IV E “When Will We Have a Vaccine?”

Administration (FDA) on testing ral infection or vaccination, to cally? And how will the United
of Covid-19 vaccine candidates are achieve community protection States share vaccine doses with
scientifically sound and indicate (also known as herd immunity), other countries, where infections
that no compromises will be made about 200 million Americans and could ultimately also pose a threat
when it comes to evaluating safe- 5.6 billion people worldwide would to Americans?
ty and efficacy.1 This commit- need to be immune in order to Releasing expert-committee re-
ment needs to be stated repeat- end the pandemic. The possibility ports, however, should not be
edly, made apparent during the that it may take years to achieve equated with successfully com-
vaccine testing and approval pro- the vaccination coverage neces- municating with the public about
cess, and supported by transpar- sary for everyone to be protected vaccine candidates and availabil-
ency. Assurances regarding the gives rise to difficult questions ity.3 In the United States and
warp speed effort to develop a vac- about priority groups and domes- many other countries, new vac-
cine or to issue emergency use tic and global access. cines and vaccination recommen-
authorizations accelerating avail- Given public skepticism of gov- dations are rarely released with
ability must make clear the ways ernment institutions and concerns substantial public information and
in which clinical trials and the about politicization of vaccine pri- educational resources. Most invest-
review processes used by federal orities, the recent establishment ments in communication with
agencies (the FDA, the National of a National Academy of Medi- clinicians and the public happen
Institutes of Health, and the Cen- cine (NAM) committee to formu- when uptake of newly recom-
ters for Disease Control and Pre- late criteria to ensure equitable mended vaccines, such as the hu-
vention [CDC]) will objectively as- distribution of initial Covid-19 vac- man papillomavirus vaccine or
sess the safety and effectiveness cines and to offer guidance on seasonal influenza vaccine, falls
of vaccines developed using new addressing vaccine hesitancy is an short of goals. Not since the
platforms. Clinicians and the pub- important step. The NAM report March of Dimes’s polio-vaccina-
lic should have easy access to should be very helpful to the tion efforts in the 1950s has there
user-friendly materials that refer- CDC’s Advisory Committee on Im- been major investment in public
ence publicly available studies, munization Practices, the group information and advocacy for new
data, and presentations related to that traditionally develops vacci- vaccines. There is already a flood
safety and effectiveness. The FDA’s nation recommendations in the of misinformation on social me-
and CDC’s plans for robust longer- United States. The NAM’s delib- dia and from antivaccine activists
term, postlicensure vaccine safety erations about which groups will about new vaccines that could be
and monitoring systems will also be prioritized for vaccination in- licensed for Covid-19. If recent
need to be made visible, particu- volve identifying the societal val- surveys suggesting that about
larly to health care professionals, ues that should be considered, and half of Americans would accept a
who are essential to the success the report will communicate how Covid-19 vaccine4 are accurate, it
of these efforts.2 these values informed its recom- will take substantial resources and
The second key part of this mendations. Will the people at active, bipartisan political sup-
question pertains to when a safe greatest risk for disease — such port to achieve the uptake levels
and effective Covid-19 vaccine will as health care workers, nursing needed to reach herd immunity
become available to some, most, home residents, prison inmates thresholds.5
or all people who want one. This and workers, the elderly, people High uptake of Covid-19 vac-
question has technical and moral with underlying health conditions, cines among prioritized groups
components, and the answers on and people from minority and should also not be assumed.
both fronts could foster or im- low-income communities — be Many people in these groups will
pede public acceptance of a vac- the first to obtain access? Alter- want to be vaccinated, but their
cine. Data from antibody testing natively, will the top priority be willingness will be affected by
suggest that about 90% of people reducing transmission by priori- what is said, the way it is said,
are susceptible to Covid-19. Ac- tizing the public workforce, essen- and who says it in the months
cepting that 60 to 70% of the tial workers, students, and young ahead. Providing compelling, evi-
population would have to be im- people who may be more likely dence-based information using
mune, either as a result of natu- to spread infection asymptomati- culturally and linguistically appro-

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PE R S PE C T IV E “When Will We Have a Vaccine?”

priate messages and materials is a professionals will need to be well- This article was published on September 8,
2020, at NEJM.org.
complex challenge. Having trust- informed and strong endorsers
ed people, such as public figures, of Covid-19 vaccination. 1. Food and Drug Administration. Devel-
political leaders, entertainment A more complete answer to the opment and licensure of vaccines to prevent
Covid-19: guidance for industry. June 30, 2020
figures, and religious and com- common question is therefore, (https://www​.­fda​.­gov/​­regulatory​-­information/​
munity leaders, endorse vaccina- “We will have a safe and effective ­search​-­fda​-­guidance​-­documents/​­development​
tion can be an effective way of Covid-19 vaccine when the re- -­and​-­licensure​-­vaccines​-­prevent​-­covid​-­19).
2. Edwards KM, Orenstein WA. Anticipat-
persuading the portion of the search studies, engagement pro- ing severe acute respiratory system corona-
public that is open to such a rec- cesses, communication, and edu- virus 2 vaccine testing, licensure, and rec-
ommendation. Conversely, per- cation efforts undertaken during ommendations for use. J Pediatr 2020;​224:​
124-8 10.1016/j.jpeds.2020.06.048.
suading people who have doubts the clinical trial stage have built 3. Nowak GJ, Karafillakis E, Larson H.
about or oppose a particular med- trust and result in vaccination Pandemic influenza vaccines: communica-
ical recommendation is difficult, recommendations being under- tion of benefits, risks, and uncertainties. In:​
Bahri P, ed. Communicating about risks and
requires commitment and engage- stood, supported, and accepted safe use of medicines: real life and applied
ment, and is often not successful. by the vast majority of the public, research. Singapore:​Springer Nature, 2020:​
Finally, surveys suggest that priority and nonpriority groups 163-78.
4. Cornwall W. Just 50% of Americans plan
physicians, nurses, and pharma- alike.” Efforts to engage diverse to get a Covid-19 vaccine. Here’s how to win
cists remain the most highly trust- stakeholders and communities in over the rest. Science. June 30, 2020 (https://
ed professionals in the United Covid-19 vaccination education www​.­sciencemag​.­org/​­news/​­2020/​­06/​­just​-­50​
-­americans​-­plan​-­get​-­covid​-­19​-­vaccine​-­here​-­s​
States. Extensive, active, and on- strategies, key messages, and ma- -­how​-­win​-­over​-­rest).
going involvement by clinicians terials for clinicians and the pub- 5. Schoch-Spana M, Brunson E, Long R,
is essential to attaining the high lic are needed now. Ravi S, Ruth A, Trotochaud M. The public’s
role in Covid-19 vaccination: planning rec-
uptake of Covid-19 vaccines that Disclosure forms provided by the authors ommendations informed by design thinking
will be needed for society to re- are available at NEJM.org. and the social, behavioral, and communica-
turn to prepandemic conditions. tion sciences. Baltimore:​Johns Hopkins
From the Harvard T.H. Chan School of Center for Health Security, 2020 (https://
Nurses and physicians are the Public Health, Boston (B.R.B.), the Univer- www​.­centerforhealthsecurity​.­org/​­our​-­work/​
most important and influential sity of Georgia Grady College of Journal- ­publications/​­t he​-­publics​-­role​-­i n​-­covid​-­19​
sources of vaccination informa- ism and Mass Communication, Athens -­vaccination).
(G.J.N.), and the Emory Vaccine Center,
tion for patients and parents. Emory University School of Medicine, At- DOI: 10.1056/NEJMp2025331
Throughout the world, health care lanta (W.O.). Copyright © 2020 Massachusetts Medical Society.
“When Will We Have a Vaccine?”

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